key: cord-0688343-imn8ou49 authors: Chen, Gaili; Wu, Qiuji; Jiang, Huangang; Zhong, Yahua title: The Impact of the COVID-19 Pandemic on Head and Neck Cancer Patients date: 2020-07-02 journal: Oral Oncol DOI: 10.1016/j.oraloncology.2020.104881 sha: d0cdaf8bff06cde0fb03ec184abad000144f49ce doc_id: 688343 cord_uid: imn8ou49 nan The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) poses an unprecedented challenge to the global healthcare system [1] , including the delivery of standard care to patients with cancer. In order to control the rapid and aggressive spread of COVID-19 since December 2019, the City of Wuhan that was the epicenter of the epidemic in China, implemented strict city lockdown and community quarantine for more than 2 months (from Jan 23 to April 8, 2020 ) that significantly halted the growth of infected patients. During this time, almost all in-hospital treatment for cancer patients was interrupted, with radiation therapy delivered only for selected patients with curative purposes following strict protection procedures. Head and neck cancer (HNC) patients represented a major clinical challenge in treatment decision-making facing this highly contagious and potentially fatal infectious disease. On one hand, surgery, radiation therapy (RT) and chemotherapy (CT) were mainstays in the treatment of early and locally advanced HNC with favored prognosis. Immunotherapy plus chemotherapy also brought substantial survival benefit to recurrent/metastatic (R/M) HNC patients [2] [3] [4] [5] [6] . On the other hand, cancer patients were more susceptible to SARS-Cov-2 infection and were more likely to develop severe and critical COVID-19 when infected [7] [8] [9] . Frequent visit to hospital in the epidemic region and receiving anti-cancer treatments with immunosuppressive properties (e.g. chemotherapy) might greatly increase the risk of getting infected. Balancing the benefit from in-hospital anti-cancer treatment and the risk of getting SARS-Cov-2 was crucial in the care of HNC cancers. Considering that radiation therapy play a critical role in HNC, the suspension of radiation therapy might lead to disease progression in these patients. It was suggested that life-saving chemotherapy and radiotherapy with curative intent should be reserved and prioritized under strict quarantine measures in lung cancer patients [10] . However, data were lack regarding HNC patients. In order to understand the impact of treatment suspension due to COVID-19 epidemic on HNC patients, we studied the clinical outcome of HNC patients who were undergoing anti-cancer treatments prior to the outbreak of COVID-19 and subsequently discontinued their in-hospital treatments in our cancer center. A total of 117 patients were eligible for analysis (Clinical characteristics in Supplementary Table S1 ). 49 patients were with early/locally advanced diseases undergoing definitive treatment including postoperative adjuvant RT or induction CT followed by concomitant chemoradiotherapy (CRT), 68 were with recurrent/metastatic diseases undergoing systemic therapy including CT, target therapy, immunotherapy or in combination. 71 patients had treatment discontinuation, among whom 22 (31.0%) had cancer progression or death (Table 1) . 23 patients discontinued definitive therapy including 13 patients undergoing postoperative adjuvant RT and 10 undergoing induction CT followed by CRT, among whom 3 (13.0%) patients suffered from disease progression ( Collectively, as cancer care and COVID-19 collide, there is no easy and universal solution to oncologic care. Although the pandemic scenario is new, the risk of mortality due to COVID-19 is seemingly lower than the risk of cancer-related death [11] . Prevention and protection measurements against SARS-Cov-2 are also greatly improved. Our work suggested that in-hospital treatment continuation with curative purposes under proper protection and a switch to oral chemotherapy for R/M HNC patients were suitable in the quarantine period. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Fair Allocation of Scarce Medical Resources in the Time of Covid-19 Pembrolizumab for Platinumand Cetuximab-Refractory Head and Neck Cancer: Results From a Single-Arm, Phase II Study Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study Antitumor Activity of Pembrolizumab in Biomarker-Unselected Patients With Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma: Results From the Phase Ib KEYNOTE-012 Expansion Cohort Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China Risk of COVID-19 for patients with cancer SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China The Management of Patients With Lung Cancer During the Outbreak of Coronavirus Disease Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic The National Natural Science Foundation of China supported this study (81602164). The sponsor had no role in the design, analysis or writing of this article. None declared.